NVSILC



centertopDraft MinutesName of Organization:Nevada Statewide Independent Living Council (NV SILC) Transition WorkgroupDate and Time of Meeting:December 10, 2020 1:00 p.m. This meeting will be held via video-conference only:In accordance with Governor Sisolak’s Declaration of Emergency Directive 006; Subsection 1; The requirementcontained in NRS 241.023 (1) (b) that there be a physical location designated for meetings of public bodies where members of the public are permitted to attend and participate is suspended.The public may observe this meeting and provide public comment on Zoom. To Join the Zoom Meeting ID: 929 904 1434Password: NVSILC (case sensitive)+1 253 215 8782 US (Tacoma)The number provided may incur long-distance telephone carrier charges, and is offered as a regional call-in number, only.Meeting ID: 929 904 1434Passcode: 707401 Find your local number: Meeting Materials Available at:, Roll Call and IntroductionsPatricia Unruh, ChairParticipants: Patricia Unruh, Julie Steinbaugh, Dee Dee Foremaster, Lucy Wroldsen, Steven Cohen, Renee Portnell, Dora Martinez, Ryan Hopkins, Sabra McWhirter, Deanna Gay, Cathy Vairo, Sandy Coyle, Regina DanielPublic Comment (Members of the public will be invited to speak, however, no action may be taken on a matter during public comment until the matter itself has been included on an agenda as an item for possible action. Please clearly state and spell your name. Public comment may be limited to 3 minutes, per person at the discretion of the chair. Agenda items may be taken out of order, combined or consideration by the public body, and/or pulled or removed from the agenda at any time. Pursuant to NRS 241.020, no action may be taken upon a matter during a period devoted to comments by the general public until the matter itself has been specifically included on an agenda as an item upon which action may be taken).There was no Public CommentDiscussion and Make Recommendations to Distribute a Survey to Personal Care Assistant (PCA) Provider Organizations and Another to their Employees (For Possible Action). Patricia Unruh, ChairRyan Hopkins will assist the group with developing and distributing their surveys. He and his team will also gather the data and provide reports. Kimberly Glass had assisted Dawn with questions as Kimberly is both a consumer of services and she had worked for a service provider, recruiting, and managing PCAs.The group is focusing on Medicare and Medicaid covered providers because of the effects of the Medicaid rate cuts have impacted the service.Dawn Lyons: Read the two different surveys aloud.PCA Provider Survey:First question, do you struggle with recruitment?Second, what do you believe a fair starting wage is for PCAs in Nevada?Third, do you provide your own training for new PCAs?Fourth, if you answered “no” to the last question, do you feel Nevada's PCA training requirements are adequate for your staff?Fifth, would it benefit your organization if you had access to a pool of workers through nursing schools?Julie Steinbaugh: Would like the regional wage question re-worded since fair, starting wages vary in different parts of the state. It will become more regionally specific.Steven Cohen: Feels that a question about other home and community billable service types might be helpful.Deanna Gay: Possibly ask the service providers how they draw their recruitment besides pay rate. Ask about what is important to their employees, what drives them there, what keeps them there and why are they leaving. She worked for years as a Direct Service Provider (DSP), there are different kinds of PCAs and case managers. She also worked with people with intellectual and developmental issues as well as physical and the elderly. It was hard to recruit and retain staff due to the stress. Pay and environment are both important to prevent burnout. Suggested a question on the survey for the service providers about how they prevent burnout in their staff, possibly active listening, support, lessen the paperwork load and opportunities for growth.Julie Steinbaugh: Suggested questions about the size of the agency and how many employees. They must see if there is a correlation between the size of the agency and number of PCAs. Translating the surveys into Spanish and Tagalog is also being looked at.It was also suggested to ask the employers, “How do you determine what hours you are paying your employees for?” In reference to unpaid time to complete paperwork.Ryan will investigate this and give information at the next meeting.PCA Satisfaction Survey:First question: How valued do you feel by your company? Extremely valued, Very valued, Somewhat valued, Not so valued, and Not at all valued.Second: Do you feel you were given adequate training? A great deal, A lot, A moderate Amount, A little and None at all.Third: What is the single most influential factor that made you take this job?Fourth: How well are you paid for the work you do? Extremely well, Very well, Somewhat well, Not so well and Not at all well.Fifth: Is your mileage reimbursed?Sixth: If you answered yes to question 5, is it a fair amount?Seventh: Do you receive insurance benefits through your employer?Eighth: How supportive do you feel your employer is? Above average, Average, and Below average.Ninth: What is one thing you would suggest to improve your workplace?Tenth: What is the single best aspect of your job?The group is interested in looking at the kind and amount of training that PCAs receive to become PCAs and what training are they getting through their employers. A consumer satisfaction survey will be developed as well.Many PCAs are required to complete a lot of paperwork but are not paid to do so. It was suggested to add a couple questions such as, “How much paperwork do you do and are you paid for it?” As well as “What were your training opportunities?, Did you receive mentoring, Did you feel safe while you were working, and did you feel your clients felt safe? Are you provided with enough Personal Protection Equipment (PPE)?” Cross-training was brought up to discuss as well. Verifying PCA visits was discussed pertaining to fraudulent or suspected fraudulent claims. PCAs now have apps on their phones that clients sign, instead of physical logs that clients used to sign at the time of service. These surveys will come from the person-centered approach.Discussion and Make Recommendations Regarding a Follow-up Letter to the Governor Sisolak Regarding Medicaid Rates for PCA’s (For Possible Action).Patricia Unruh, ChairDawn Lyons: Heard back from the Commission on Aging (COA), about collaborating with them on supporting home and community-based services including PCA services in the letter of support to the Governor. The COA has already written a letter and sent it.Here is their letter:the letter is dated November?16, 2020, to Governor Sisolak.“Dear Governor Sisolak programs through the Department of Health and Human Services require the flexibility to address the ever changing service needs throughout Nevada right now.We encourage the Governor and the Nevada legislators to continue to provide the Department of Health and Human Services with the ability to transfer funds amongst the various budget accounts within the department with the approval of the interim finance committee that was granted through AB3 in the special session.The State of Nevada has vigilantly ensured individuals eligible for longterm services and supports receiving high quality and cost effective person centered care that's imperative to individual needs and wishes even during a pandemic.Striving to promote access to services in home and community based settings has been an integral part of what we do.This pandemic has been devastating to our communities and has shed light on our state's longterm care facilities.Home and community based services enable children, individuals living with disabilities, and older adults to ensure their in a variety of settings that provide alternatives to institutionalization.We believe that it's imperative we accelerate reform efforts and rapidly modernize delivery of home and community based services that provide more cost effective person centered and integrated options for individuals with disabilities and aging populations.Home and community based services include homemaker services, home health aide services, personal care services, adult day health services, respite care, rehabilitation services, day treatment and partial hospitalization programs and other cost effective services that are essential.Continued flexibility is so vital in providing necessary tools to adjust critical priorities in an ever changing environment.Respectfully the commission on aging”.The SILC Transition Workgroup decided to write their own letter to the Governor, supporting the COA and waiting on data that is being collected before sending it.Sabra McWhirter motioned for Dawn to draft a letter to the Governor. Regina Daniel seconded. Motion carried.Discussion and Make Recommendations Regarding Potential Models to Use for SILC Education Plan and Which Entities to Recommend SILC Present to (For Possible Action).Patricia Unruh, ChairThis item was tabled.Discussion Regarding AARP’s Long-Term Services and Supports State Scorecard for Nevada Found at: Unruh, ChairDawn shared her screen which showed the scorecard. This is Nevada specific and put out by AARP. Nevada ranked 51 in affordability and access, which is not good. The top line under Affordability and Access, median annual nursing home ages 65 and up.From the year 2015 to '16, the state rate was 257% and from 2018 to '19, 236%.The average across the nation is 245%. Nevada ranked 28th.She then scrolled to the bottom under Effective Transitions.Nevada ranked 45 out of the states and territories which is also not good..The most current data we have is 2017, '18 regarding the percentage of short stay residents who are successfully discharged to the community.Nevada is pretty close to the U.S. average but, again, it's a couple years ago.We also need to take the Covid Pandemic into account why Nevada’s numbers would be so much higher or our ranking would be probably a little worse based on some of the trainings Dawn has attended and some of the community forums she has attended with others in the IL community. She has heard some of the other states’ Centers For Independent Living, their efforts to reduce institutionalizations and increase the transitions during the COVID pandemic and it's been amazing what people have been able to do.But for some reason Nevada hasn't done that as much.AARP wasn't able to find several transitions for this year from nursing homes. Dawn does not think they have much nursing home data.It could be based on other barriers as well. For the transitions, for the people with disabilities in specific, everybody in a nursing home is a person with a disability, whether they're in the aging population or not.It’s difficult to glean any meaningful data about Nevada’s current position, but AARP did a great job for 2016 and 17 in gathering this data.Perhaps the SILC could get together with AARP, partner with them and have AARP help the SILC with some of the data that they got and invite AARP to the SILC’s next meeting to share some input on this subject. They can provide the SILC with some of their methodology behind this data and where they found their nursing home data and data collection issues.Dawn requested the members to submit questions for AARP, to her.Approve Next Meeting Agenda Items and Next Meeting Date (For Possible Action)Patricia Unruh, ChairWhat other states have done successfully as far as Medicaid rates. Deanna Gay will present on this.Item #5 that was tabledRevisit the surveys-design and distribution. Ryan Hopkins to come back.AARP to come and talk about their survey.Life Coaches-Dee Dee Foremaster to present on this.Letter to the GovernorNext meeting date will be on February 4, 2021, from 11:00am to 1:00 pm.Public Comment (Members of the public will be invited to speak, however, no action may be taken on a matter during public comment until the matter itself has been included on an agenda as an item for possible action. Please clearly state and spell your name. Public comment may be limited to 3 minutes, per person at the discretion of the chair).Dawn Lyons: Thanked Ryan and the new people who joined.Ryan Hopkins: He can bring other people and if they would like to present, he will contact Dawn.Patricia Unruh: Is excited about possible changes in the state.Adjournment Patricia Unruh, ChairNOTE: We are pleased to make reasonable accommodations for members of the public who have disabilities and wish to attend the meeting. If special arrangements for the meeting are necessary, please notify Wendy Thornley at (775) 687-0551 as soon as possible and at least five days in advance of the meeting. If you wish, you may email her at wthornley@adsd. According to NRS 241.020, supporting materials for this meeting is available at: 3416 Goni Road, #D-132, Carson City, NV 89706 or by contacting Wendy Thornley at (775) 687-0551 or by email at wthornley@adsd.. Agenda Posted at the Following Locations:Notice of this meeting was posted on the Internet: and In accordance with Nevada Governor Sisolak’s Declaration of Emergency Directive 006 there will not be a physical location for the Nevada Statewide Independent Living Council (NV SILC) Legislative Subcommittee. ? As per Nevada Governor Sisolak’s Declaration of Emergency Directive 006; Subsection 3: The requirements contained in NRS 241.020 (4) (a) that public notice agendas be posted at physical locations within the State of Nevada are suspended. ? As per Nevada Governor Sisolak’s Declaration of Emergency Directive 006; Subsection 4: Public bodies must still comply with requirements in NRS 241.020 (4)(b) and NRS 241.020 (4)(c) that public notice agendas be posted to Nevada’s notice website and the public body’s website, if it maintains one along with providing a copy to any person who has requested one via U.S. mail or electronic mail. ? As per Nevada Governor Sisolak’s Declaration of Emergency Directive 006; Subsection 5: The requirement contained in NRS 241.020 (3)(c) that physical locations be available for the public to receive supporting material for public meetings is suspended. ? As per Nevada Governor Sisolak’s Declaration of Emergency Directive 006; Subsection 6: If a public body holds a meeting and does not provide a physical location where supporting material is available to the public, the public body must provide on its public notice agenda the name and contact information for the person designated by the public body from whom a member of the public may request supporting material electronically and must post supporting material to the public body’s website, if it maintains one. ................
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